Respiratory syncytial, parainfluenza and influenza virus infection in young children with acute lower respiratory infection in rural Gambia

Grant A Mackenzie,Marianne A B Van Der Sande,Lisa A Wijsman,Sharon Van Den Brink,Thushan I De Silva,Pieter Overduin,Beate Kampmann,Adam Meijer,Aminata Vilane,Lenny Hogerwerf,Thierry K S Janssens,Rasheed Salaudeen

doi:10.1038/s41598-019-54059-4

Abstract

Respiratory viral infections contribute significantly to morbidity and mortality worldwide, but representative data from sub-Saharan Africa are needed to inform vaccination strategies. We conducted population-based surveillance in rural Gambia using standardized criteria to identify and investigate children with acute lower respiratory infection (ALRI). Naso- and oropharyngeal swabs were collected. Each month from February through December 2015, specimens from 50 children aged 2–23 months were randomly selected to test for respiratory syncytial (RSV), parainfluenza (PIV) and influenza viruses. The expected number of viral-associated ALRI cases in the population was estimated using statistical simulation that accounted for the sampling design. RSV G and F proteins and influenza hemagglutinin genes were sequenced. 2385 children with ALRI were enrolled, 519 were randomly selected for viral testing. One or more viruses were detected in 303/519 children (58.4%). RSV-A was detected in 237 and RSV-B in seven. The expected incidence of ALRI associated with RSV, PIV or influenza was 140 cases (95% CI, 131–149) per 1000 person-years; RSV incidence was 112 cases (95% CI, 102–122) per 1000 person-years. Multiple strains of RSV and influenza circulated during the year. RSV circulated throughout most of the year and was associated with eight times the number of ALRI cases compared to PIV or IV. Gambian RSV viruses were closely related to viruses detected in other continents. An effective RSV vaccination strategy could have a major impact on the burden of ALRI in this setting.

Highlights

Respiratory viral infections contribute significantly to morbidity and mortality worldwide, but representative data from sub-Saharan Africa are needed to inform vaccination strategies
Cycle threshold (Ct) values for IV A and B controls generated from RNA extracted from STGG were consistently slightly higher than those generated from RNA extracted from the gold standard GLY, and similar was observed for RSV A and B controls
Our analyses from population-based surveillance in 2015 in rural Gambia provide reliable data on the incidence of acute lower respiratory infection (ALRI) associated with RSV, PIV and IV, its clinical characteristics and a detailed description of the circulation of RSV, PIV and IV throughout the year with genotypic descriptions of the prevalent RSV and IV

Summary

Introduction

Respiratory viral infections contribute significantly to morbidity and mortality worldwide, but representative data from sub-Saharan Africa are needed to inform vaccination strategies. Each month from February through December 2015, specimens from 50 children aged 2–23 months were randomly selected to test for respiratory syncytial (RSV), parainfluenza (PIV) and influenza viruses. In order to address the ongoing burden of virus-associated ALRI and to develop evidence-based vaccination strategies, additional data are needed from low-income settings. Recent case-control studies from low-income countries have established an etiologic association between ALRI and respiratory syncytial (RSV), parainfluenza (PIV), influenza (IV) and human metapneumo viruses[4,5]. These studies could not calculate disease incidence. We evaluate specimen collection and storage methodologies and analyse antigenic sites that may impact on vaccination strategies

Methods

Results

Conclusion